Meaningful Use: Clinical Quality Measures

Dwane J. McGowan 18th April, 2013

Meaningful Use

The use of certified electronic health records (EHRs) in a meaningful use (MU) way leads to established reimbursements rates for physicians and hospitals.

MU involves abiding by criteria set by the HHS and administered by the CMS and requires meeting core and menu objectives dealing with specific areas such as:

Use of certified EHRs in ways that can be evaluated quantitatively and qualitatively.Use of EHRs to submit clinical quality measures

(CQMs). Use of EHRs for e-exchange of information to improve the quality of health care.

MU focuses on reporting of quality measures, improved efficiencies, data capture and sharing, patient-centered care, improved safety, and meeting set CQMs to name a few.

Emphasis is shifting from volume of health care delivered to the actual quality and effectiveness of care received, and an increased focus on patient-centered care.

MU is directly tied to reaching goals in process and outcomes of health care delivery, and involves e-reporting of quality of care measures from 2014 onwards.

Meaningful Use

CQMs are a way of assessing treatment, observation of patient care, processes and experiences, efficient use of resources, care coordination, and clinical guideline applications.

Measures should be based on evidence-based practices shown to deliver the best results for the most patients.

Quality measures adopted should be related to one or more of the Institute of Medicines health care quality goals outlined in the Crossing the Quality Chasm report:

Effective Efficient Safe Patient-centered Equitable Timely

Clinical Quality Measures

In 2012 the CMS released the final rule for Stage II criteria including CQMs that must be met for MU incentive payments.

All providers must report on CQMs in 2014, regardless of their MU stage of adoption.

Under Stage I MU: EP's must meet 6 CQM's, 3 core and 3 elective, while hospitals must meet all 15 CQM's. By 2014 EP’s must meet 9/64 measures, and EHs must meet 16/29 measures, with all providers required to meet 3/6 measures from the National Quality Strategy (NQS) domains:

Patient safetyPatient and family engagementCare coordinationPopulation and public health.Efficient use of health care resourcesClinical processes/effectiveness

Clinical Quality Measures

Clinical Quality Measures(Adapted from CMS 2014 CQMs)

CQM Development

The National Quality Forum (NQF) is an independent nonprofit agency engaged by the CMS to develop measures, recommendations and goals aimed at achieving the six-pronged focus of the NQS domains.

The NQF works with many health care stakeholders such as government agencies, health care entities, providers, insurance agencies, and patient advocacy groups to evaluate and endorse tools for standardized performance measurement.

Beginning in 2014 all providers using EHRs certified to the 2014 Edition Standards and Criteria will be required to report CQMs in an electronic format.

The measure selection process bases recommendations on measure usability, feasibility, and scientific acceptability and include: 

Conditions that represent national public health priorities.

Conditions that are common health disparities.Conditions that contribute to the morbidity and

mortality of the most CMS patients.Conditions that disproportionately drive health care

costs and could improve with better quality management.

Measures that would enable states and CMS providers to measure quality of care in new dimensions with a stronger focus on parsimonious measurement. In 2013 EPs can use an e-Reporting Pilot program, and the

Physician Quality Reporting System (PQRS), while EHs can use the Hospital Inpatient and Outpatient Quality Reporting Program (IQR, OQR).

The CMS will accept current reporting mechanisms but encourages e-reporting using certified EHRs for 2014 and beyond, as the electronic specifications include updated coding and logic corrections.

CQM Development cont’d

To assist providers in e-reporting CQMs the CMS has developed e-specifications for each CQM including data elements, logic, and definitions for that measure in a Health Level 7 standard known as Health Quality Measures Format (HQMF).

HQMF represents a clinical quality measure as an electronic Extensible Markup Language (XML) document, which is captured or stored in an EHR and then sent or shared.

These specifications allow EHRs to capture, calculate, and report CQMs, which may be described in 3 ways; HTML- human readable form, XML- computer readable for reporting, Value sets- specific codes used by developers and maintained by The National Library of Medicine Value Set Authority Center (VSAC).

The CMS maintains an eCQM Library with human readable files for specifications for each CQM, and provides explanations about measures, sponsors, rationale, and calculation parameters.

CQM Reporting

CQMs are central to providing quality care and assessing areas for improvement.

MU requirements for CQM s must be met in order to receive federal funds.

CQMs are developed using evidence-based practices and must meet in some aspect part of the NQS domains.

All providers, regardless of MU stage, will be required to e-report their CQMs to the CMS.

Assistance is available for providers at the eCQM Library, maintained by the CMS.

Key CQM Points

ANY QUESTIONS?